Predicting Lung Deposition of Extrafine Inhaled Corticosteroid-Containing Fixed Combinations in Patients with Chronic Obstructive Pulmonary Disease Using Functional Respiratory Imaging: An in Silico Study

Background: Functional respiratory imaging (FRI) is a computational fluid dynamics-based technique using three-dimensional models of human lungs and formulation profiles to simulate aerosol deposition. Methods: FRI was used to evaluate lung deposition of extrafine beclomethasone dipropionate (BDP)/formoterol fumarate (FF)/glycopyrronium bromide (GB) and extrafine BDP/FF delivered through pressurized metered dose inhalers and to compare results with reference gamma scintigraphy data. FRI combined high-resolution computed tomography scans of 20 patients with moderate-to-severe chronic obstructive pulmonary disease (mean forced expiratory volume in 1 second 42% predicted) with in silico computational flow simulations, and incorporated drug delivery parameters to calculate aerosol airway deposition. Inhalation was simulated using profiles obtained from real-life measurements. Results: Total lung deposition (proportion deposited in intrathoracic region) was similarly high for both products, with mean ± standard deviation (SD) values of 31.0% ± 5.7% and 28.1% ± 5.2% (relative to nominal dose) for BDP/FF/GB and BDP/FF, respectively. Pairwise comparison of the deposition of BDP and FF gave a mean intrathoracic BDP/FF/GB:BDP/FF deposition ratio of 1.10 (p = 0.0405). Mean intrathoracic, central and peripheral deposition ratios for BDP were 1.09 (95% confidence interval [CI]: 1.05-1.14), 0.92 (95% CI: 0.89-0.96), and 1.20 (95% CI: 1.15-1.26), respectively, and for FF were 1.11 (95% CI: 1.07-1.15), 0.94 (95% CI: 0.91-0.98), and 1.21 (95% CI: 1.15-1.27), within the bioequivalence range (0.80-1.25) for intrathoracic and central regions, and slightly exceeding the upper boundary in the peripheral region. Mean ± SD central:peripheral deposition (C:P) was 0.48 ± 0.13 for BDP/FF/GB and 0.62 ± 0.17 for BDP/FF, indicating a higher proportion of drug deposition in the small airways than in the large airways. Conclusion: FRI demonstrated similar deposition patterns for extrafine BDP/FF/GB and BDP/FF, with both having a high lung deposition. Moreover, the deposition patterns of BDP and FF were similar in both products. Furthermore, the C:P ratios of both products indicated a high peripheral deposition, supporting small airway targeting and delivery of these two extrafine fixed combinations, with a small difference in ratios potentially due to mass median aerodynamic diameters

Performance of the Fully Digital FPGA-based Front-End Electronics for the GALILEO Array

In this work we present the architecture and results of a fully digital Front End Electronics (FEE) read out system developed for the GALILEO array. The FEE system, developed in collaboration with the Advanced Gamma Tracking Array (AGATA) collaboration, is composed of three main blocks: preamplifiers, digitizers and preprocessing electronics. The slow control system contains a custom Linux driver, a dynamic library and a server implementing network services. The digital processing of the data from the GALILEO germanium detectors has demonstrated the capability to achieve an energy resolution of 1.53 per mil at an energy of 1.33 MeV.Comment: 5 pages, 6 figures, preprint version of IEEE Transactions on Nuclear Science paper submitted for the 19th IEEE Real Time Conferenc

Absences from work among healthcare workers: are they related to influenza shot adherence?

BACKGROUND: The coverage for influenza vaccination among healthcare workers (HCWs) is inadequate in many countries despite strong recommendations; is there evidence that influenza vaccination is effective in preventing absenteeism? Aim of the study is to evaluate the influenza vaccination coverage and its effects on absences from work among HCWs of an Italian academic healthcare trust during the 2017-2018 influenza season. METHODS: We performed a retrospective study to identify predictive characteristics for vaccination, and a retrospective cohort study to establish the effect of vaccination on absences among the vaccinated and non-vaccinated cohorts between December 2017 and May 2018. Overall absence rates over the whole observation period and sub-rates over 14-days intervals were calculated; then comparison between the two groups were conducted applying Chi-square test. RESULTS: Influenza vaccination coverage among 4419 HCWs was 14.5%. Age, university degree, medical care area and physician profile were positively associated with vaccine uptake. Globally during influenza season non-vaccinated HCWs lost 2.47/100 person-days of work compared to 1.92/100 person-days of work among vaccinated HCWs (p\u2009<\u20090.001); significant differences in absences rates resulted when focusing on the influenza epidemic peak. CONCLUSIONS: Factors predicting influenza uptake among HCWs were male sex, working within medical care area and being a physician. Absenteeism among HCWs resulted to be negatively correlated with vaccination against influenza. These findings add evidence to the urgent need to implement better influenza vaccination strategies towards HCWs to tackle vaccine hesitancy among professionals

Bose-Einstein source of intermittency in hadronic interactions

The multi-particle Bose-Einstein correlations are the source of ''intermittency'' in high energy hadronic collisions. The power-law like increase of factorial moments with decreasing bin size was obtained by complete event weighing technique with gaussian approximation of space-time particle emitting source shape. The value of source size parameter was found to be higher than the common one fitted with the help of the standard Handbury Brown-Twiss procedure.Comment: 12

The burden of severe cases of Influenza disease: The Friuli Venezia Giulia Region experience

IIntroduction. Influenza is a matter of serious concern for clinicians, in both outpatient and in-hospital settings. Worldwide, the 2017-18 epidemic proved to be the most severe since 2003-04. We report a real-world experience regarding the management of patients with influenza admitted to a large teaching hospital in the Friuli Venezia Giulia region during the 2017-2018 influenza season. We also provide a practical guide for the management of hospitalized influenza patients. Methods. A retrospective observational analysis was conducted among all influenza patients requiring admission to our center during the 2017-18 season. Results. Overall, 29 patients were admitted to the University Hospital of Udine during the 2017-18 season with a diagnosis of influenza. B virus was responsible for the majority of cases. More than 65.5% of the subjects presented with a complication. We estimated that 41.4% of the patients admitted were affected by a \u201csevere form\u201d. All these cases required admission to the Intensive Care Unit, with 27.6% and 10.3% needing Orotracheal Intubation and Extracorporeal Membrane Oxygenation, respectively. The fatality rate was 24.1%. Notably, only 9 subjects in our cohort had been vaccinated. Based on the experience acquired during the past season, we propose a practical guide to the management of influenza cases in everyday hospital practice. Conclusion. The cornerstones of the management of all hospitalized influenza patients are the rapid identification and treatment of severe forms. Timely and strict adherence to contact and respiratory precautions are also fundamental to reducing the risk of intra-hospital outbreaks. Despite improvements in antiviral therapies and supportive measures, influenza-related morbidity and mortality remain high. In our opinion, a universal vaccination program is the only safe and effective method of filling the gap

Small scale dynamics of a shearless turbulent/non-turbulent interface in dilute polymer solutions

We study the physics of the turbulent/non-turbulent interface (TNTI) of an isolated turbulent region in dilute polymer solutions and Newtonian fluids. We designed an experimental setup of a turbulent patch growing in water/dilute polymer solutions, without mean shear and far from the walls. The observations from the experiments are complemented and expanded by simulations performed using a localised homogeneous forcing to generate the turbulent front and the Finitely Extensible Elastic model with the Peterlin closure model for the polymer stress. The comparison, which shows that when Newtonian and viscoelastic TNTIs are fed by the same energy they behave in similar manner both in the experiments and in the simulations, permits to extend the applicability, on a qualitative basis, of single relaxation time polymer models also to turbulent/non-turbulent interfaces. From the detailed analysis offered by the numerical results, the alterations in the dynamics between strain and vorticity help understanding the mechanics of the polymer action on the TNTI without mean shear. The reduced vorticity stretching and increased vorticity compression terms are found to be due to the modified degrees of alignment between vorticity, polymer conformation tensor, and rate-of-strain tensor eigenvectors observed especially near the interface. These alignments at the smallest scales of the non-Newtonian turbulent flow lead to a reduced production of enstrophy and consequently to a reduced entrainment, which in this problem are seen as reduced advancement of a turbulent region

Propagation of ultra-high energy protons in the nearby universe

We present a new calculation of the propagation of protons with energies above $10^{19}$ eV over distances of up to several hundred Mpc. The calculation is based on a Monte Carlo approach using the event generator SOPHIA for the simulation of hadronic nucleon-photon interactions and a realistic integration of the particle trajectories in a random extragalactic magnetic field. Accounting for the proton scattering in the magnetic field affects noticeably the nucleon energy as a function of the distance to their source and allows us to give realistic predictions on arrival energy, time delay, and arrival angle distributions and correlations as well as secondary particle production spectra.Comment: 12 pages, 9 figures, ReVTeX. Physical Review D, accepte

Strangeness Report

The paper provides a short report on strangeness production in ultrarelativistic nucleus-nucleus collision, with the main stress on strange particle abundances.Comment: Proceedings of Quark Matter 200

Estimating the inelasticity with the information theory approach

Using the information theory approach, in both its extensive and nonextensive versions, we estimate the inelasticity parameter $K$ of hadronic reactions together with its distribution and energy dependence from $p\bar{p}$ and $pp$ data. We find that the inelasticity remains essentially constant in energy except for a variation around $K\sim 0.5$, as was originally expected.Comment: 14 pages, 8 figures. Misprints correcte